Elective cesarean section versus vaginal delivery: a paradigm shift in obstetrics?

Over the past 20 years, the rate of cesarean section has undergone a marked increase on a global level,and it appears unlikely that this trend will be reversed in the near future. This fact has also raised a number of questions regarding the growing preference for elective cesarean section following a complication-free pregnancy and in the absence of medical indications. This is amply illustrated by the results of a study questioning British obstetricians,which shows that 31% of female obstetricians elected to deliver by means of cesarean section in cases where there was no medical necessity whatsoever. Both the mortality rate of carefully prepared procedures of this kind and the attending morbidity rate have been successfully reduced in recent years owing to improvements in section technique, causing certain of the maternal and fetal risk, accompanying vaginal delivery to come under closer scrutiny than before. The potential damage to the perineum during birth - and the impairment of the parturient's sexuality this may cause - in conjunction with the fact that vaginal delivery continues to expose the infant to certain risks which cannot be ruled out entirely has made the choice between vaginal delivery and cesarean section increasingly difficult. The argument most frequently cited in favor of vaginal delivery concerns the unimpaired birth experience it offers. Many women, however, do not consider this a high priority. In keeping with the greater importance currently being assigned to patients' preferences, the authors support the view that the parturient herself should be enabled to decide what level of risk is acceptable to her, including stating her preference for a delivery by cesarean section. It cannot be stressed enough that, in this context, comprehensive information and rigorous documentation are indispensable requirements.